Serviço de Neurorradiologia, Hospital Beatriz Ângelo, Loures, Portugal.
University of Wisconsin, 600 Highland Avenue, Mail code 3252, Madison, WI 53792, United States.
Eur J Radiol. 2017 Nov;96:162-172. doi: 10.1016/j.ejrad.2017.08.014. Epub 2017 Aug 24.
Imaging plays a central role for intravenous and intra-arterial arterial ischemic stroke treatment patient selection. Computed tomography (CT) / CT angiography or magnetic resonance (MR) / MR angiography imaging are used to exclude stroke mimics and haemorrhage, to determine the cause and mechanism of stroke, to define the extension of brain infarct and to identify the arterial occlusion. Imaging may identify the patients that will be benefit more from revascularization therapies independently of the conventional therapeutic time window allowing individualized treatment decisions and improving individual patient outcome. Multiparametric CT/MR imaging may be used to identify the extension of potential viable brain tissue (penumbra) and of irreversible brain lesion (core) using CT perfusion and/or diffusion weighed and perfusion weighted MR imaging. The status of the arterial collateral circulation and the type and extension of the clot may be assessed by imaging. The accuracy and the clinical significance for treatment and patient clinical outcome of different imaging techniques are reviewed.
影像学在静脉和动脉内急性缺血性脑卒中治疗患者选择中起着核心作用。计算机断层扫描（CT）/CT 血管造影或磁共振成像（MR）/MR 血管造影用于排除脑卒中样发作和出血，确定脑卒中的病因和发病机制，确定脑梗死的范围，并识别动脉闭塞。影像学可以识别出那些将从血管再通治疗中获益更多的患者，而不受常规治疗时间窗的限制，从而可以做出个体化的治疗决策，改善患者个体的预后。多参数 CT/MR 成像可用于通过 CT 灌注和/或弥散加权和灌注加权 MR 成像识别潜在可存活脑组织（半暗带）和不可逆脑损伤（核心）的范围。通过影像学可以评估侧支循环的状态以及血栓的类型和范围。本文回顾了不同影像学技术的准确性及其对治疗和患者临床预后的临床意义。
